Diagnosing and Treating Breast Cancer – How to Find Your Way in the Oncological Jungle?

In previous articles , I have emphasized how important it is to do a breast self-examination. No one will take care of you as well as you do. Do you feel uncertain about how to properly examine your breasts? There are many instructions with pictures available online that will guide you in the right way to do the examination. If you still feel like you are doing it wrong, ask your gynecologist to show you the right technique. It is important to do it regularly and in the first phase of your menstrual cycle. We examine ourselves and suddenly we feel something. Breathe in, breathe out, calm down - feeling a lump in your breast is not always a sign of malignant tumors. Very often these are benign changes (simple cysts, fibroadenomas, lipomas, etc.), but we definitely cannot ignore it and should see a doctor. You can go to a gynecologist who will verify whether there is a lump or not, and if you are sure of its existence, you can go for a breast ultrasound right away. If you want to do it free of charge under the National Health Fund, then an earlier visit to a gynecologist is unavoidable (the doctor must issue you a referral). In this option, you have to expect a wait - how long? It varies depending on the center and its workload. You can always look for one that has closer dates. If you want to go for a private ultrasound and avoid the queues - you don't need a referral. You go to a clinic that provides such services and simply "buy" a breast ultrasound. There are long queues for some specialists in the private sector, but there will certainly be no problem finding a center that will do it "on the spot" and this does not mean that the service will be of lower quality (many factors influence this: the number of hours of services provided, price, location, etc.).

We also recommend reading the article about the structure and development of breasts .

Before entering the ultrasound room, we need to talk about one thing. Because if we don't talk about it now, you'll Google it as soon as you leave. There is a scale that standardizes the description of breast examinations, whether in ultrasound, mammography, or MRI. It's the BI-RADS scale developed by the American Radiological Society. Every description of a breast imaging examination will be graded on this scale. And so, in a nutshell:

BI-RADS 0 - the lesion cannot be assessed (e.g. due to breast structure). Additional imaging tests or correlation of the current test with previous ones are necessary.

BI-RADS 1 - normal examination, without any pathologies

BI-RADS 2 - benign lesions present

BI-RADS 3 - probably benign lesion, risk of malignancy <2%. Follow-up examination recommended: ultrasound in six months.

BI-RADS 4 - this is where it gets complicated, because the risk of malignancy is from 2 to 95%, which is why this class is divided into 3 sub-items:

1. a) low risk of malignancy >2% but <10%
2. b) medium risk of malignancy >10% but <50%
3. c) high risk of malignancy >50% but <95%

BI-RADS 5 - high risk of malignancy >95%

BIRADS 6 - if we had previously diagnosed cancer (e.g. in biopsy) and we monitor its growth/shrinkage. This class may seem strange, but it applies to patients who, for example, have chemotherapy and are just getting ready for surgery. Additionally, there are patients who, for some reasons, do not undergo surgical treatment (e.g. they use unconventional methods of treatment) and in their case, monitoring of the change is also important.

Okay, we have done a breast ultrasound and now there are several scenarios in which the specialist:

1. does not confirm the existence of pathology (BI-RADS 1) - we could have simply made a mistake and felt a fragment of the gland. Alternatively, it could have been a change related to trauma (from underwear, running, etc.) and could have resorbed by the time we reported for ultrasound. We are free! We are back to the self-examination phase.
2. states that our change is benign and does not raise suspicions of cancer (BI-RADS 2). He will recommend a control test.
3. is not sure about the morphology of the lesion (BI-RADS 0) and sends us for a consultation ultrasound examination, or possibly wants to perform a mammogram. As I mentioned earlier, ultrasound and mammography complement each other, which is why some changes are better assessed by ultrasound and others by mammography.
4. he doesn't like our lesion (BI-RADS 4, less often 3). He doesn't clearly state that it's a tumor, but it has many features that don't allow him to clearly state that it's a benign lesion. Then he usually sends us to an oncological surgery clinic to verify the lesion and possibly do a biopsy (more on that later). And I keep repeating - don't worry, it doesn't mean that you definitely have cancer and that you have to be treated in that clinic. Histopathological verification is simply needed. So we don't just look at the lesion in imaging tests, but we also want to look at a section of it under a microscope to assess it more thoroughly.
5. states that the change seen in the examination is a malignant tumor (or at least with a certainty of over 95%; BI-RADS 5). Only the previously mentioned histopathological examination from the biopsy tells us that something is 100% cancer, which is why we are sent for it urgently, regardless of whether we had the ultrasound done in a “public” or private clinic.

If you haven't breathed a sigh of relief and a check-up is not enough, you go to an oncological surgery clinic (as I wrote in my previous text about breast care , in Poland surgeons usually take care of breasts). You have been referred for a biopsy. It is most often performed under local anesthesia (just like at the dentist's with an injection, at first it is unpleasant because of the sting and burning, then it's all downhill ;) ). It is not the most pleasant, because its full name is core needle biopsy and as you can guess it is not performed with a typical syringe needle. But thanks to it in 2 to 4 weeks you will know exactly what your breasts are hiding and you will establish a further plan of action with your doctor. Maybe somewhere in your head there is a question: why, if the doctor is >95% certain in the ultrasound examination, he will not refer me for removal of this lesion right away? Because it is not known for sure what kind of malignant tumor is growing in your breast, what its receptor status is and what type of surgery and further treatment will be best for you. Believe me, some things are much more complicated than they seem and you just have to trust the doctors.

Ok, let's move on. You have the histopathology result. A better option is of course a benign lesion. Depending on what kind of benign lesion it is and what size, there are different procedures. It can be observed in imaging tests - if it is small, does not grow and does not change its morphology. The second option is to remove it. Your opinion is important here. If you prefer to avoid the scalpel, but at the same time commit to keeping your finger on the pulse - fine, we will observe. Sometimes, however, it is better to simply get rid of the problem. Especially if, for example, you are planning a pregnancy, because why should you be nervous at the same time about a cyst, which may look a bit different due to the hormonal storm in your body. Benign lesions, depending on their size and location, can be removed in the same office under local anesthesia, or as part of a one-day surgery or a larger operation and a longer hospital stay. The doctor will certainly explain everything to you and present the options available in a given facility.

Let's move on to the second scenario, which involves a more radical approach. Malignant tumor. As I mentioned earlier, not all "cancer" is the same. And I'm not just talking about the size of the tumor or possible involvement of lymph nodes. We live in the 21st century, where we determine not only the histology of the tumor, but also the presence of individual receptors in its tissues, as well as the number of mitoses or other molecular markers. I won't elaborate on all this, because not all of us are oncologists and let's leave the treatment to specialists ;) I just wanted to tell you that the most important thing right now is to trust your doctors and follow their recommendations. Regarding the prognosis, I don't like talking about numbers, because they seem inhuman to me and when I look at a patient, I don't want to overwhelm her with one- or five-year survival rates. The prognosis for breast cancer is good, we live in times when it's getting better year by year and that's what you need to stick to. Doctors will either refer you to treatment that is intended to prepare you for surgery or they will refer you to surgery right away.

After surgery, there are also various options - radiotherapy, chemotherapy, hormone therapy. You will have precise recommendations on what, how and where. Don't worry, you are not alone and it is not about being happy that others are also feeling bad, but drawing from the solidarity of wonderful women who also "happened" to get cancer. The incidence of breast cancer is increasing all over the world, and in Poland in 2019 the number has already reached 18-19 thousand per year. There are many organizations that bring together patients affected by this disease, and links to their websites are provided below. There you will find a lot of information about your disease, dates of various workshops, service options (e.g. cosmetic :) ) or forums where you can share your experiences. Remember that in cancer, oncological treatment is the most important, but you cannot forget about your mental and physical condition, so if the situation is overwhelming, it is a good idea to think about psychological therapy, and if for some reason you feel that you cannot cope with the physical consequences of the surgery on your own, go to a physiotherapist. Take care of yourself! Remember that in today's world, cancer is starting to change its nature and from diseases that are a sentence for a person, they are becoming chronic diseases that you have to learn to live with. You will undergo the entire treatment and you will report for check-ups as often as your oncologist recommends. And let's stick to this scenario. Of course, there are patients who leave us too early, but let them remain painful exceptions, confirming the rule that you can live with breast cancer.

In summary, breasts are great. It's great to wonder which bra they look better in and whether the cleavage isn't too big. It's wonderful if the biggest problem is that they could be a tad bigger/smaller/more perky/less perky (cross out the unnecessary ones). The problem is when our sadness doesn't only concern their appearance, but the change that has occurred in them. Let's examine them, take care of them, and when the moment of the great battle comes, let's gather all the energy and act!

Is going braless healthy? Find out here.

PS Forgive me for focusing mainly on women in this article, but breast changes mostly concern women. Of course, if you are a member of the opposite sex and you feel something on your breast, also run to the doctor and have it verified, and if it turns out that you need further diagnostic and therapeutic procedures, everything I wrote applies to you as well.

Patient organizations/associations/foundations:
- Amazons (breast cancer): https://amazonki.net/
- Blue Butterfly (female cancers): https://bluemotyl.pl/
- Rak'n'Roll (tumors in general): https://www.raknroll.pl
If you want to search for information about cancer on the Internet, I recommend sites created by doctors for patients, e.g.
- https://www.mp.pl/pacjent/onkologia/chorobynowotworowe/162061,breast-cancer
- https://www.onkonet.pl/dp_np_rakpiersi.php